1123 - Tuberculoma from Primary Pulmonary Tuberculosis Causing Thoracic Spinal Cord Injury: A Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

JH

Jeremy Holden, DO

Resident Physician
Dell Medical School
Austin, Texas, United States
HV

Huu T. Vo, MD

Resident Physician
University of Texas at Austin, Dell Medical School
Austin, Texas, United States

Co-Author(s)

KW

Kristin Wong, MD

Associate Professor
University of Texas at Austin, Dell Medical School
Austin, Texas, United States

Submitter(s)

JH

Jeremy Holden, DO

Dell Medical School
Austin, Texas, United States

Case Diagnosis: A patient with primary pulmonary tuberculosis developed a tuberculoma causing a thoracic spinal cord injury.

Case Description: A 66 year old male presented with a 3 month history of worsening paraplegia and numbness, later with bowel and bladder incontinence. He also reported a chronic cough and persistent right-sided chest wall mass. An MRI showed a large destructive mass at the T5-6 level causing spinal cord compression. He underwent a T3-8 posterior instrumented fusion and T5-6 decompression with resection of the spinal mass. Pathology showed necrotizing granulomatous inflammation with acid-fast bacilli. His sputum was positive for Mycobacterium tuberculosis and he subsequently started on standard tuberculosis antimicrobials. He demonstrated marked improvement in motor function following decompression. Spontaneous voiding was restored, though he continued to require an intensive bowel regimen. He was discharged to a specialized tuberculosis hospital until he was cleared for inpatient rehabilitation.

Discussions: This patient represents a rare manifestation of tuberculosis involving the spinal cord. Pott’s disease is the spread of tuberculosis to the spine itself, usually from another primary site. It is estimated that Pott’s disease accounts for around 2% of global tuberculosis cases. Tuberculomas are caseating granulomatous masses resulting from hematogenous spread of tuberculosis. In the central nervous system, these are more common in the brain than abutting the spinal cord. Surgical decompression is often required to alleviate neurological dysfunction. Intensive multidisciplinary rehabilitation helps to address functional deficits from the mass.

Conclusions: This case demonstrates the importance of clinically correlating all symptoms when working up a new spinal mass. In this patient, chronic cough, pulmonary lesions, and other osseous lesions may suggest systemic infection like tuberculosis versus other malignancy. Surgery was necessary to decompress the spinal cord but also for pathological diagnosis confirming tuberculoma. Having a higher index of suspicion will guide diagnosis and prompt earlier antimicrobial therapy.